Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects

By Sidney Jones, SPT

Background

Osteoarthritis (OA) is a common degenerative joint disease that is usually associated with pain, limited range of motion, muscle weakness, difficulty with activities of daily living and impaired quality of life. The knee is the most common joint in the body affected by osteoarthritis. Low-level laser therapy has been studied and used for pain control, anti-inflammatory effects and its healing efficacy. The purpose of this study was to determine the effects of adding low-level laser therapy (LLLT) to an exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, knee range of motion, and quality of life in older subjects with knee OA.

Participants

Men and women between 60-72 years old with chronic osteoarthritis according to the American College of Rheumatology (ACR) criteria grades II & III and knee OA according to the Kellgren-Lawrence grade. Participants also had to have the ability to stand independently and willingness to participate in the study.

Methods – laser therapy treatment

Group1: 18 subjects 7 males & 11 females were treated with a laser dose of 6 J/cm² over 8 points around the knee. Each point received energy of 6 J/point for 60 seconds.

Group 2: 18 subjects 6 males & 12 females were treated with a laser dose of 3 J/cm² on 9 points around the knee. Each point received energy of 3 J/point for 50 seconds.

Group 3: 15 subjects 5 males & 10 females participated as the control group. Procedure was identical but without emission of energy.

Exercise Training Program

All participants in each group participated in the same exercise training program for 30 to 45-minute sessions 2 times a week for 8 weeks. The program included stretching the quadriceps, hamstrings, adductors, and calf muscles. Strengthening exercises included knee extension, straight leg raises and quadriceps setting. All participants were instructed to practice these exercises as a home program.

Each participant was evaluated pre and post 8 weeks of physical therapy interventions on:

  • Pain intensity with Visual Analogue Scale (VAS)
  • Physical function with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
  • Knee range of motion, active knee flexion range of motion was measured with long arm universal goniometer.
  • Isometric strength of knee flexor and extensor muscles was measured using Handheld Dynamometer

 Results

The best improvements in VAS, WOMAC pain, knee range of motion and physical function were seen in patients who were treated with 6 J/cm² then 3 J/cm² and then placebo group. Mean values for WOMAC significantly reduced, which means improved physical function. Isometric strength of the quadriceps and hamstring muscles increased significantly in each group after interventions. The largest increase in isometric strength of the quadriceps and hamstring muscles and knee flexion range of motion was seen in patients who received 6 J/cm² followed by 3 J/cm² and then the placebo group. Mean values of knee flexion range of motion increased significantly after physical therapy interventions in each group with significant differences among the 3 groups.

Discussion about adding laser therapy

The current study suggests that adding LLLT to exercise training program could be an important modality for treating older adults with OA than exercise training alone. The active laser groups either 6 J/cm² or 3 J/cm² had a significant reduction of pain intensity in VAS and WOMAC, increase in physical function, increase in isometric quadriceps and hamstring muscle strength, and increase in range of motion after treatment of knee OA.

Conclusion

Adding LLLT to an exercise training program is more effective than exercise training alone in treatment of patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm² or 3 J/cm².

PTF Approach to adding laser therapy 

Here at Physical Therapy First, we perform a complete evaluation and based on those findings we design a treatment plan that best addresses our patient’s needs. Our goal is to provide quality patient care and as this study suggests, multiple interventions can and should be used to treat knee osteoarthritis simultaneously. At Physical Therapy First, laser therapy and strengthening are options along with several other interventions such as soft tissue mobilization, stretching and providing our patients with a home exercise program to maximize outcomes.

Original Article about Laser Therapy

Youssef, E. F., Muaidi, Q. I., & Shanb, A. A. (2016). Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. Journal of Lasers in Medical Sciences,7(2), 112-119. doi:10.15171/jlms.2016.19

Running with Knee Osteoarthritis-Part 3

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine.  Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the third of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary

PARTICIPANTS:

This paper is a systematic review and meta-analysis, so the authors compiled research on knee osteoarthritis (OA) and running, and summarized the findings in order to provide a concise recommendation based on the general consensus of research. Articles were included if they: were level I-III evidence, written in English, used physician diagnosed OA with clinical and/or radiographic findings, and running was compared to non-running. Articles that compared running to other forms of exercises were not included in this study.

METHODS:

Literature searches were performed, and 1,907 articles were reviewed. Of those, 25 met their inclusion criteria. Statistical analysis was performed on those 25 studies to come to a meta-analysis, which summarizes and confirms the general recommendations based on significant research.

CONCLUSIONS:

The authors concluded that recreational running was in fact associated with lower levels of OA when compared to sedentary individuals. Competitive running was associated with higher levels of OA than recreational runners. Overall, sedentary subject demonstrated the most symptomatic OA. The study also argues that this simply compares runners to non-runners. So the only conclusion that can be drawn is that running is better than being sedentary. More research should be done into seeing if running vs other forms of exercise is the best for of exercise.

 PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther, 47(6), 373-390. doi:10.2519/jospt.2017.7137

Running with Knee Osteoarthritis-Part 2

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine. Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the second of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary:

PARTICIPANTS:

Men and women 45-79 years old, were grouped into 3 groups.
1: No symptoms of knee osteoarthritis, and deemed low risk for developing knee osteoarthritis
2: No symptoms of knee osteoarthritis, and deemed high risk
3: Symptoms of knee osteoarthritis

METHODS

Patients were labeled as high volume runners, low volume runners, or non-runners. X-rays and pain questionnaires were provided at the start of the study, again at a 2 year follow up. Pain questionnaires were provided at the final 8 year follow up

RESULTS

Any history of running-low or high volume was associated with lower knee pain. There was slightly lower evidence of knee osteoarthritis on the x-rays of runners, but it was not statistically significant. Statistically the highest predictor of knee pain was BMI.

CONCLUSIONS

Other factors besides running seem to have more of an impact on symptomatic knee osteoarthritis. It is possible that wince runners tend to be more active and have lower BMI, that any potential damage is offset by the benefits of regular exercise.

PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Lo, G., Driban, J., Kriska, A. McAlindon, T., Souza, R., Petersen, N., Storti, K., Eaton, C., Hochberg, M., Jackson, R., Kwoh, K., Nevitt, M., Suarez-Almazaor, M. (2017). History of Running is Not Associated with Higher Risk of Symptomatic Knee Osteoarthritis: A Cross-Sectional Study form the Osteoarthritis Initiative. Arthritis care res, 69(2), 183-191. doi:10.1002/acr.22939.

Running with Knee Osteoarthritis-Part 1

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine.  Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the first of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary

Often of most concern with running is whether the impact is harmful to the knee joint, as the thought is impact could cause and/or worsen osteoarthritis. Osteoarthritis is the term given to changes that occur along a joints surface as we age. The most common way to diagnose osteoarthritis is with an x-ray. A prospective study published in The American Journal for Preventative Medicine investigated whether running as we age increases the severity or frequency of knee arthritis.

PARTICIPANTS

45 long distance runners who were 50 years old or older, and had been running for at least 10 years; and 53 controls who were 50 years or older and did not run for exercise.

METHODS

Initial x-rays were taken of both knees of all participants. Over the next 18 years, 5 follow up x-rays were taken of each patient. These x-rays were graded on a standard scale to quantify the severity of knee arthritis.

RESULTS

Runners did not show higher rates or more severe cases of knee osteoarthritis than non-runners

CONCLUSIONS

Models found that higher BMI, higher initial damage on x-ray, and age to be most strongly correlated with arthritis on x-ray. There was no data to suggest that running, gender, previous knee injury, or total exercise time contributed to osteoarthritis of the knee. In short-go out and go for your run!

 PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. Often tight and/or weak muscles, stiff joints, and poor movement patterns can contribute to pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Chakravarty, E., Hubert, H., Lingala, V., Zatarain, E., Fries, J. (2008). Long Distance Running and Knee Osteoarthritis A Prospective Study. American Journal of Preventative Medicine, 35(2), 133-138. doi:10.1016/j.amepre.2008.03.032.

Physical Therapy and Online Programs to treat Hip Osteoarthritis, Knee Osteoarthritis, or Both

by John A. Baur, PT, DPT, OCS, CSCS, FAAOMPT
Physical Therapist

Many people are finding information about treatments for health conditions on the internet. A novel approach to physical therapy takes advantage of this propensity to engage online with treatment. This blended approach combines face-to-face visits with an online program or e-Exercise. But is this as effective as traditional physical therapy?

Comparing a Blended Approach with Traditional Physical Therapy

Researchers in a recent study[i] compared the short and long-term effectiveness of a blended approach, which uses an online e-Exercise program to the traditional approach of physical therapy alone. They focused on patients with osteoarthritis of the knee and/or hip. This condition is the most common chronic condition of the joints, causing pain, stiffness and swelling.

Research Participants

The study enrolled 208 patients selected from 143 physical therapy practices. Patients had to meet the following criteria:

· 40 – 80 years of age

· Osteoarthritis of the hip and/or knee

· Not on a waiting list for hip or knee replacement surgery

· No contra-indications for physical activity without supervision

· Moderately physically active

· No current physical therapy program in the last 6 months

· Access to the internet

Blended Approach

This approach combines physical therapy with an online application. It involves 5 face-to-face sessions with a physical therapist and enrollment in an e-Exercise program that has a graded activity module, exercises and information modules. Once the patient is enrolled in the online, e-Exercise program, the physical therapist can adapt the program to the patient’s needs and monitor login frequencies and assignment evaluation. They can then discuss progress during the face-to-face physical therapy session.

Traditional Approach

The traditional approach to treating osteoarthritis over a period of 12 months involves 12 face-to-face sessions with a physical therapist. During those sessions the physical therapist will share information about the disease and treatment and work the patient on a program of physical exercise and strength and stability exercises.

Results

Patients were assessed at 3 and 12 months on quality of life, physical functioning and physical activity. The assessment used an online questionnaire.

At 12 months there was no difference between the groups on health-related quality of life, physical functioning or physical activity. Both approaches achieved the same results.

Recommendations

When choosing between a blended approach that incorporates e-Exercise and traditional physical therapy, the preferences and predisposition of the patient should be considered. The blended approach requires more motivation on the part of the patient and they must take a more active role for the treatment to be successful. If the blended approach is used, it may also be wise to incorporate a personal activity tracker to keep patients motivated and on task.

Physical Therapy First Approach – Treatment for Osteoarthritis

At Physical Therapy First each patient undergoes a complete examination to determine the underlying biomechanical cause of her/his knee/hip osteoarthritis. Physical therapy can help knee/hip osteoarthritis and it all starts with a thorough examine which will include assessing:

– muscle imbalances

– specific muscle weakness

– muscle flexibility

– joint mobility

– shoe wear assessment

– functional movement

– posture

– neurological exam

Based on the finding from the initial physical therapy assessment, a custom treatment plan will be designed to restore movement quality and efficiently, and ultimately decreasing the pain resulting from knee/hip osteoarthritis.

Some of the treatments that may be provided in physical therapy to help address patients with osteoarthritis includes:

– individualized online/e-Exercise program

– adaptive equipment

– bracing

– proper shoe wear

– joint mobilization

– soft tissue mobilization

– specific muscle strengthening

– muscle stretching

– postural correction

– correction of biomechanical faults in functional movement

– physical therapy modalities, such as, moist heat, cold packs, ultrasound, electrical stimulation, phototherapy/laser

[i] Corelien J J Kloek, Daniël Bossen, Peter M Spreeuwenberg, Joost Dekker, Dinny H de Bakker, Cindy Veenhof; Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial, Physical Therapy, Volume 98, Issue 7, 1 July 2018, Pages 560–570, https://doi.org/10.1093/ptj/pzy045